Key result
Intensive SBP target under 120 mmHg remains controversial across major CKD guidelines.
Why the study?
The optimal systolic blood pressure target for patients with chronic kidney disease remains debated despite evidence from the SPRINT trial and differing guideline recommendations.
Should the systolic blood pressure target in patients with CKD be <120 mmHg compared to standard targets?
Should the systolic blood pressure target in patients with CKD be <120 mmHg compared to standard targets?
This review discusses the ongoing controversy regarding optimal blood pressure targets in CKD and provides consensus suggestions for implementing an intensive <120 mmHg SBP goal in daily practice.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“There is little justification for two guidelines published over the span of 5 months using exactly the same evidence to provide highly divergent recommendations.”
“Data from the SPRINT findings suggest that the cardiovascular benefits of intensive BP reduction may outweigh the risks in patients with mild to moderate CKD.”
“This study demonstrates that evidence about blood pressure targets from SPRINT can be personalized to adults with hypertension and CKD by using each individual's estimated risks and preferences for multiple outcomes related to blood pressure lowering, which could help facilitate shared decision-making conversations.”
Ongoing debate on <120 mmHg SBP targets in CKD warrants caution; leaves open resolution by new randomized trials.
For several decades, there was no clinical-trial evidence to demonstrate that intensive blood pressure (BP)-lowering is a therapeutic strategy that prolongs survival and reduces the cardiorenal risk of patients with chronic kidney disease (CKD). In 2015, the landscape changed after the publication of the SPRINT (Systolic Blood Pressure Intervention Trial). Compared with a standard (<140 mmHg) systolic BP (SBP), an impressive cardiovascular and survival benefit was observed with an intensive (<120 mmHg) SBP target in non-diabetic patients with hypertension and high cardiovascular risk provoking premature termination of SPRINT. In 2017, a prespecified subgroup analysis of SPRINT showed that the benefit of intensive BP-lowering was similar in patients with or without CKD. As expected, this landmark trial has substantially influenced the BP target recommendations from the guidelines released thereafter. In 2021, the KDIGO guideline made a breakthrough with the adoption of the intensive SBP target of SPRINT for the management of hypertension in CKD. However, other major medical panels, like ESC, ERA, NICE, ACC and AHA have been reluctant to follow the same approach and the optimal BP goal in CKD continues to be debated. In this article, we provide evidence defending and opposing the position that the SBP target in CKD should be <120 mmHg. We conclude with a consensus and suggestions for the successful implementation of this intensive SBP target in daily clinical practice.
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Dounousi et al. (2026) conducted a review in Chronic kidney disease (CKD) and hypertension. Intensive systolic blood pressure target vs. Standard systolic blood pressure target (<140 mmHg) was evaluated. An intensive systolic blood pressure target of <120 mmHg compared to a standard <140 mmHg target in chronic kidney disease remains debated among major clinical guidelines.
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